Clinicopathologic correlations of silent corticotroph adenomas of the pituitary: Report of four cases and literature review

Sahli, Rahel; Christ, Emanuel; Seiler, Rolf W.; Каппелер, Андреас; Vajtai, István

doi:10.1016/j.prp.2006.01.007

Cited by 28 publications

(34 citation statements)

References 21 publications

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“…New onset postoperative hypopituitarism has been reported in up to half of SCAs [10,50,61] including postoperative adrenal insufficiency [10,29,42,45,46,61] though other studies did not confirm these differences [9,19]. While SCA recurrence rates of up to 60% have been documented [4,5,10,19,50,61], these rates do not differ from those observed with nonfunctioning adenomas [5,8,63].…”

Section: Clinical Coursementioning

confidence: 93%

“…Alternatively, SCAs may be incidentally diagnosed when brain MRIs are performed for unrelated reasons [30]. SCAs therefore generally present as non-secreting macroadenomas, and pre-operative laboratory studies reveal normal cortisol levels and normal to low LH/FSH and sex steroid and normal to slightly elevated prolactin (PRL) levels [4,30,45,61]. Some SCAs may have elevated ACTH levels with normal cortisol levels [43,50,52,56,61].…”

Section: Clinical Coursementioning

confidence: 99%

“…However, up to 20% of clinically inapparent corticotroph adenomas, known as silent corticotroph adenomas (SCAs), do not manifest biochemical or clinical evidence of hypercortisolism [9,29,45]. These adenomas are resected usually because of mass effects, and patients are followed post-operatively for persistent or recurrent mass growth with serial MRIs, and monitored for development of subsequent hypopituitarism [4,10,29,50,61].…”

Section: Introductionmentioning

confidence: 99%

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Silent corticotroph adenomas

2018

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Purpose-Silent corticotroph adenomas (SCAs) comprise 20% of all corticotroph adenomas and 3-19% of nonfunctioning adenomas (NFAs). As they do not manifest clinical or biochemical hypercortisolism, they are diagnosed after pathologic examination of resected tumor tissue demonstrates positive ACTH expression. While preoperative features are similar to those of NFAs, SCAs may have more cavernous sinus invasion. Further, patients with SCAs tend to have more frequent and earlier recurrences than those with NFAs, often necessitating multiple surgeries and other modalities of treatment. This article reviews the incidence, pathogenesis, and clinical behavior of SCAs.Methods-A systematic literature review was performed using PubMed for information regarding silent corticotroph adenomas.Results-Up to date findings regarding epidemiology, pathogenesis, pathology, clinical presentation, postoperative course, and management of patients with SCAs are presented.Conclusions-This review highlights the necessity of rigorous monitoring for recurrences and hypopituitarism in patients with SCAs.

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Section: Clinical Coursementioning

confidence: 93%

Section: Clinical Coursementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Silent corticotroph adenomas

2018

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“…They account for 1.1-6% of surgically removed pituitary adenomas (2-5) and 17-22% of ACTHimmunoreactive tumours (4,6). The sex predominance, as reported in neurosurgical series, remains unclear.…”

Section: Adenomas Corticotróficos Silenciososmentioning

confidence: 99%

“…SCAs may often show pathological evidence of previous regressive change in the form of cholesterol clefts, haemosiderin deposition and fibrosis (4,7). This may appear on imaging as cystic change, suggesting in some instances an alternative preoperative diagnosis of craniopharyngioma (6).…”

Section: Pathology and Pathogenesismentioning

confidence: 99%

Silent corticotroph adenomas

Karavitaki

Ansorge

Wass

2007

Arq Bras Endocrinol Metab

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Silent corticotroph pituitary adenomas (SCA) are defined as pituitary adenomas showing positive staining for adrenocorticotrophic hormone in immunohistochemical studies, but not associated with perioperative clinical or laboratory features of hypercortisolaemia. They account for 1.1-6% of surgically removed pituitary adenomas. Currently, two distinct pathologic subtypes of SCA are recognised. Their pathogenesis remains unclear. They present with local mass effects (headache, visual deterioration, cranial nerve palsies, endocrine dysfunction). The lack of manifestations of cortisol excess has not been conclusively explained. In surgical series, most tumours are macroadenomas with suprasellar extension present in 87-100% of the cases; this is in contrast to Cushing's disease, which is mostly attributed to microadenomas. Surgery remains the main therapeutic approach. Attempts to identify predictors of recurrence have not been successful. Management and follow-up protocols should be planned taking into account their potential aggressive behaviour, particularly upon recurrence. The development of florid pituitary Cushing's syndrome and local recurrence followed by metastatic disease (occasionally outside the central nervous system) have been rarely reported. Adenomas corticotróficos silenciosos (ACS) são definidos como adenomas hipofisários que apresentam coloração positiva para o hormônio adrenocorticotrófico em estudos imuno-histoquímicos, mas não são associados com achados clínicos ou laboratoriais peri-operatórios de hipercortisolemia. São responsáveis por 1,1-6% dos adenomas hipofisários removidos cirurgicamente. Atualmente, dois subtipos patológicos distintos de ACS são reconhecidos, mas sua patogênese permanece obscura. Eles se apresentam com efeitos de massa local (cefaléia, deterioração visual, paralisia de nervos cranianos, disfunção endócrina). A ausência de manifestações de excesso de cortisol não é suficientemente explicada. Em séries cirúrgicas, a maioria dos tumores são macroadenomas com extensão suprasselar, presente em 87-100% dos casos, em contraste com a doença de Cushing, que é principalmente atribuída a microadenomas. A cirurgia continua a principal ação terapêutica. A tentativa de se identificar preditores de recorrência tem sido mal sucedida. Protocolos de manejo e acompanhamento devem ser planejados levando-se em consideração o seu comportamento potencialmente agressivo, particularmente na recorrência. Raramente tem sido reportado o desenvolvimento de síndrome de Cushing hipofisária florida e recorrência local, seguida de doença metastática (ocasionalmente fora do sistema nervoso central).

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Pituitary Apoplexy

Briet¹,

Chanson²

2018

Endocrine and Metabolic Medical Emergencies

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Clinicopathologic correlations of silent corticotroph adenomas of the pituitary: Report of four cases and literature review

Cited by 28 publications

References 21 publications

Silent corticotroph adenomas

Silent corticotroph adenomas

Silent corticotroph adenomas

Pituitary Apoplexy

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